Kerry Ann Xhaferi
Tucson,AZ
Summary
Certified Pharmacy Technician, proficient in assisting pharmacists in meeting customer needs. Well-organized, with solid experience coordinating with insurance providers, prescribers and individuals for claim reconciliation. Skilled in relationship-building and multitasking. Areas of focus: PBM, Specialty, Order Entry, Prior Authorizations, Home Delivery, Fertility medication, billing-medical coding, and LTC pharmacy.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Pharmacy Technician/Patient Advocate
Gainwell Technologies, LLC (through staffing agency, DSI, Inc.)
05.2023 - 08.2023
- Providing "one call resolution services" in collaboration with pharmacists, providers, in advocating for members, to optimize patient care in obtaining medications under OH-Medicaid guidelines, Unified Price Drug List for Managed Care and Fee for Service Members, adherence to CMS regulation, and knowledge of programs specific to OH-Medicaid, HIPAA and other protocol and mandates as regulated.
- Performing order entry, prior authorization requests review and approval, following OH-Medicaid criteria, processing corrections, prescription editing clarification, and edit overrides, for real-time adjudication; perform technical pharmacy calculations for days supply, dosing schedule, daily dosing, and cost constraints; application of PA decision trees for ICD-10 code, duplicate therapies, tried and failed, BvD, step-therapy, high-dollar claims, administrative denials, and statement of medical necessity criteria; and, Grievances and Appeals creation and tracking as warranted for.
- Application of resources including drug shortages (substitutions) as documented in ASHP, lookup formularies, integration of EHR/Prior Authorization/Claim Adjudication system (Proprietary System) VUERx360/PAWs, Evergreen (proprietary SharePoint), and Ohio Department of Medicaid website; Gainwell Technologies Resources (e. g. covered OTCs, specialty pharmacy criteria, dual-eligibility lookup, and diabetic supplies, for example), ICD-10 Lookup; compendia for determinations (Pharmacist links); provider links, and information reconciliation to main claims processing system, VUERx360 (Workforce Management/PAWs) which provided platform for both working claim adjudication (including edit overrides), and Prior Authorization processing, IEX virtual phone system for calls, texting, faxing, and follow-up, and chat messaging.
Certified Pharmacy Technician
PharMerica Closed-Door Pharmacy
02.2023 - 04.2023
- Completion of new admissions, routine orders, and cycle runs
- Enter queued prescriptions for over 50 Skilled Nursing and Assisted Living Facilities for servicing 4, daily, weekday runs, and weekend runs as contracted
- Entering prescriptions using AS-400 System
- In conjunction with DocuTrack, and Point and Click for up-to-date census information; triaging incoming pharmacy orders/requests via phone, intercom, and fax with internal IV department and pharmacists; Track and monitor delivery manifest information upon request throughout day to and with facilities Directors of Nursing
- Completing routine checks for correct intake, medication order, fulfillment, re-order inventory, review of all aspects of meeting demands for quality assurance, for providing ongoing and temporary medication maintenance, to long-term care facility members.
Pharmacy Technician
Walgreens Boots Alliance (through staffing agency, Iconma, LLC)
08.2022 - 01.2023
- I was responsible for two queues in providing Quality Assurance: Registration and Research: Consisted of verification of all profile information for new prescriptions, refill requests, transfers; information, shipping for accuracy of demographics; Insurance information, and re-routing or routing appropriately, to allow for Order Entry to work incoming prescriptions upon vetting.
- Order Entry: Entering all home delivery prescriptions, following all conventions for entering directions (SIG), quantity, Days-Supply, ordering physician, refills, and consolidation of refills as permitted under “Comprehensive State Law,” to allow for up to a 90-days supply
- Prescriptions were primarily for maintenance medications, including “specialty,” and some “single-use” prescriptions
- Included diabetic medications/supplies, aerosols, eye/ear drops, and starter/maintenance and tapering dosing
- Creating exceptions for proper prescription handling
- All prescriptions were summarily reviewed for quality assurance by in-house pharmacist.
Pharmacy Technician Senior, PA Specialist
OptumRx (through Staffing Agency, Equity Staffing)
10.2021 - 02.2022
- -Receiving inbound calls, nationwide, requesting prior authorization or inquire on status or formulary, for Commercial, Medicare Advantage, MPD, and other plans pharmaceuticals, primarily from medical offices/facilities, and some patient calls
- Completed Clinical Guidelines for approval at technician level or pended to pharmacist, upon assuring quality of following protocols, regulations and company-specific guidelines
- Integrated multiple systems for outreach, linking to patient portal, CoverMyMeds.com; updates/implementation of processes, regulations, and contracts; utilizing PAS (Prior Authorization System) and Navigator/Kana Enterprises (Legacy Catamaran) Also worked FAXes and ePA's.
- Coordinated verification and filling of more than 40 daily prescriptions in high-volume, remote, callcenter pharmacy environment
- Streamlined prescription processing with accurate data entry and verification of patient information
Pharmacy Technician, Third-Party Processing
OptumRx (through Staffing Agency, Randstad)
01.2021 - 09.2021
- Working in Third-Party Exceptions/pharmacy benefit management, using Enterprise Pharmacy System, assisting in transition of business platform to I.R.I.S
- Going live 9/12/2021
- Processing third-party claims and initiating prior authorization requests for pharmacy Fertility and Infusion Services, business segment – providing specialty pharmacy medication, non-sterile and sterile compounding, fertility drugs; and contracted, specialty drug services/products to specialized client-base; overnight, refrigerated delivery with comprehensive fertility program/infertility program services, and financial assistance and case management integrative oversight
- Assuring all claims were processed according to CMS standards for submission.
Pharmacy Technician
DLH, Contractor For Dept Vet Affairs, SW CMOP
08.2020 - 12.2020
- Quality Assurance in labeling correctly to show NDC, Medication name, Lot#, and complete label instructions and label instructions.
- Assisted in maintaining clean and organized work environment, ensuring compliance with safety regulations.
Captioning Agent
Sorenson Communications/CaptionCall
02.2020 - 07.2020
- Captioning Agents (CA's) utilize assistive-voice-recognition technology to caption telephone calls for the deaf and hard of hearing, to provide verbatim captioning
- These services are regulated by the Federal Communications Commission, and are deemed essential services for emergency and communication services.
Pharmacy Technician (multiple Roles)
OptumRx/Optum Home Delivery/BriovaRxSpec.
08.2017 - 02.2019
- Prior-Authorization: Receive calls nationwide from provider offices (hospitals); occasionally patients, requesting prior authorization for pharmaceuticals based on Member-specific plan for medications requiring clinical pharmacist review for Tier-cost-exception, Step Therapy, Non-Formulary Exception, Claim $, Concurrent Review, Quantity Limits, Benefit Limits, Opioid Over-Utilization, MED (Morphine Equivalent Dose) Reviews, BvsD Medicare reviews, Pre-coverage determinations; and dual reviews
- Use of Prior Authorization System (PAS); RxHD, Legacy Catamaran, SharePoint, and new systems and plans as well as platform migration from RxHD to Navigator
- Home-Delivery Program: Working queues focusing on review of and processing prescriptions for non-specialty medications (Tiers 1-3, and OTC), for home-delivery
- Queue assignments – for example, consisted of updating prescription SIG, data entry of prescriptions; correct NDC selection, calculating day supply, refills, and all aspects of legal prescription fill from order to ready for delivery
- Use of IRIS system for prescription order processing and auxiliary support programs
- BriovaRx Specialty Pharmacy: Processing referrals requesting new, refill, specialty medications such as Oral-Chemotherapy, Psoriatic Arthritis, neurological agents, HIV, Auto-immune disorders; Transplant, Self-Administration and Office-Based medications/some infusion-based medications, Hormone-Growth therapy, HEP-C, and Crohn's disease; assuring quality for zero-error production for processing referral and completion for being specialty needed to be to assure timely fulfillment as well as accurate dosing, and correction of all errors noted upon receipt of referral prior to submittal
- Research source of referral and detailed review to address prescription issues correcting order in ScriptMed and entry of prescriptions; faxing prescriber for clarification, triage for a verbal prescription or clarification between Provider and BriovaRx pharmacist
- Use of multiple resources from OptumRx/ BriovaRx Specialty as updated, Clinical Pharmacology, in addition to implementing regulatory changes/updates to medications
- Route referrals not handled by BriovaRx re-routed to dedicated teams/distros
- Transfer/Intake of prescriptions between pharmacies.
Claims Technical Assistance Specialist
Cenpatico IC, Data Analytics (Aerotek Staffing)
02.2016 - 07.2016
- Receive, respond to, and educate medical claim-provider-related issues by initiating updates to database operations towards delivery of mental and physical health services for the Regional Behavioral Health Authority (RBHA), integrated care system, serving Southern Arizona for AHCCCS, and dually-eligible qualified Members; providing quality assurance measures such as update to subsystems, and providing educational materials to providers concerning correct resubmittals or reasons for rejection
- Centene (Cenpatico IC) was contracted to perform as Southern Arizona's Regional Behavioral Health System for dually-eligible patients as of October 2015, and implemented ICD-10-CM content for claim assessment and adjudication.
Billing-Coding Specialist Hospital Claims
TITAN HEALTH MANAGEMENT SOLUTIONS
05.2014 - 11.2015
- Review of UB-04 claims for six hospitals in AZ, CA, and NV, for Dignity Health, scrubbing claims following revenue cycle management: from inception through adjudication; referencing, CMS policy/regulation, insurance carrier contracts, and hospital regulations; for inpatient, outpatient, and transitional claim types; meeting contracted production levels and quality assurance audits by Dignity
- Request assistance from hospital departments
- Use of Artiva claims integrative software; Siemens Imaging; HIE (Health Information Exchange); SSI Claims reviewer; HIE integrative records system, and SMS mainframe Hospital Association systems
- Completing inception of claim through successful adjudication and payment of claims processed on behalf of Dignity Health Association of Hospitals, following through on rebills, and transitional payments encountered in billing cycle for hospitalizations which would oftentimes include pharmaceutical billing, and and post-discharge billing falling under same encounter
- Continual monitoring of work for quality assurance by Dignity Health Hospital System.
Office Level Support III (Program Coordinator), Case Management
PIMA HEALTH SYSTEM ARIZONA LONG-TERM CARE SYSTEM (ALTCS)
02.2010 - 09.2011
- Backup to Intake Coordinator: Establish New Member 'virtual profile,' daily intakes into ALTCS program, using AZ ADOA AHCCCS, QNXT 3.4, Amisys, and CMS systems for HCBS, ALF, and SNF enrollees
- Verification of COB in AHCCCS and with SNF business managers; Developed Access database 'Disaster Registry,' profiling 2,400, home-based Members for emergency response; Developed PowerPoint training module on Aprima, for behavioral health specialists and clinicians; Backup Lead Receptionist, for 100 staff; 4200 members, and providers.
Accountant and Assistant to Finance Officer
COURTNEY REALTY & INVESTMENT CO., INC
12.2005 - 01.2010
- Full-charge bookkeeping and payroll for 12 entities; investment, property management, and new construction, using QuickBooks Contractor Premier Edition; tracking job costing, allocation, and progress payments.
Accountant Associate
SYSTEMS & INDUSTRIAL ENGINEERING, UNIVERSITY OF ARIZONA
09.2002 - 11.2005
- P-Card transactions/reconciliation; online requisitioning; biweekly payroll preparation for over 150 department staff
- Preparation and recordkeeping of all personnel and payroll actions and forms; Local/international travel/ employment paperwork for various visa types; Check Requests, journal entries, direct deposits, requests for budget change
- Reporting for discretionary/foundation funds; Financial coordinator for 'Stochastic Programming Conference.'
Office Specialist, Sr. / Fund Accountant
FINANCIAL MANAGEMENT/FSO, UNIVERSITY OF ARIZONA
10.1999 - 07.2002
- Reviewed for approval, all University-wide, financial documents, researching account appropriateness and availability of funds and overseeing submitted documents for adherence to correct preparation per current policy
- Other duties: Online procurement review and approval process; Setup New Account creates using account classification conventions; report and prepare memo wire request, for bi-monthly, UPI payroll transmittal using AFIS (State system) for State Pay-In and Claim, UIS (University Information System) database OBC for drill-down reporting for supervisor, Associate Controller for the University of Arizona; Training of staff in all University-wide business offices on the Financial Operations on Individual Reimbursements procedures, budget allocations and remaining budget, transfer of funding; Student-worker supervisor for State Operating Funds unit; Documentation of steps undertaken in source document review processes, to assist the transition to an e-business, web-based (post-audit) environment; Daily journal entries to mainframe for reconciliation of shadow-bookkeeping systems utilized by colleges, schools, and business offices comprising the UofA campus and Sierra Vista campus.
Chief Financial Officer
MARANA HEALTH CENTER, INC
02.1999 - 07.1999
- Prepared revised budget, proposal and e-reporting for federal funding to Department of Health and Human Services (HHS); implementing Specific Requirements and reporting measures, to restore federal funding for Marana Health Center from federally-funded probationary status
- Secured ongoing funding with reporting and program stipulations in place for a two-year period.
Education
Allied Health Professional Medical Scribe - Allied Health Professional Advanced Fast Track
American Healthcare Documentation Professionals Group (AHDPG)
Dorchester, MA08.2019
CPC-A And ICD-10-CM Proficiency - Professional Medical Coding Curriculum, AAPC Align
The American Academy of Professional Coders
Nationwide Credential - Training L&S Coding, LLC.12.2013
Certificate of Completion - Professional Paralegal, Centers For Legal Studies
University of Colorado At Boulder
Boulder, CO01.1999
Accounting - Accounting 26 Credit Hours
Pima Community College
Tucson, Arizona, Pima County, PCCC Campuses01.1994
Associate of Science - Chemical Technology "Cert. American Chemical Soc."
City College of San Francisco
San Francisco, CA06.1976
Skills
- Order Entry, PBM, QA, Prior Authorizations, Claims Adjudication, Revenue Cycle Management,
- Medicare A/B/C/D (Advantage), Medicaid, dual eligibility, MCO's PPO's, FQRC, Tricare, and Commercial insurances, application of protocols
- Customer Relations working independently and collaboratively using CRM, SharePoint, relational DBs
- Technical/medical terminology communication skills; business writing, confidentiality, and etiquette
Certification
- CPhT, 30175585, Pharmacy Technician Certification Board, 08/30/25
- CPC-A, American Academy of Professional Coders, 01291870, 12/2013, 09/30/24
- T075626, AZ State Board of Pharmacy, 01/20/22, 10/31/25
References
References available upon request.
Timeline
Pharmacy Technician/Patient Advocate
Gainwell Technologies, LLC (through staffing agency, DSI, Inc.)
05.2023 - 08.2023
Certified Pharmacy Technician
PharMerica Closed-Door Pharmacy
02.2023 - 04.2023
Pharmacy Technician
Walgreens Boots Alliance (through staffing agency, Iconma, LLC)
08.2022 - 01.2023
Pharmacy Technician Senior, PA Specialist
OptumRx (through Staffing Agency, Equity Staffing)
10.2021 - 02.2022
Pharmacy Technician, Third-Party Processing
OptumRx (through Staffing Agency, Randstad)
01.2021 - 09.2021
Pharmacy Technician
DLH, Contractor For Dept Vet Affairs, SW CMOP
08.2020 - 12.2020
Captioning Agent
Sorenson Communications/CaptionCall
02.2020 - 07.2020
Pharmacy Technician (multiple Roles)
OptumRx/Optum Home Delivery/BriovaRxSpec.
08.2017 - 02.2019
Claims Technical Assistance Specialist
Cenpatico IC, Data Analytics (Aerotek Staffing)
02.2016 - 07.2016
Billing-Coding Specialist Hospital Claims
TITAN HEALTH MANAGEMENT SOLUTIONS
05.2014 - 11.2015
Office Level Support III (Program Coordinator), Case Management
PIMA HEALTH SYSTEM ARIZONA LONG-TERM CARE SYSTEM (ALTCS)
02.2010 - 09.2011
Accountant and Assistant to Finance Officer
COURTNEY REALTY & INVESTMENT CO., INC
12.2005 - 01.2010
Accountant Associate
SYSTEMS & INDUSTRIAL ENGINEERING, UNIVERSITY OF ARIZONA
09.2002 - 11.2005
Office Specialist, Sr. / Fund Accountant
FINANCIAL MANAGEMENT/FSO, UNIVERSITY OF ARIZONA
10.1999 - 07.2002
Chief Financial Officer
MARANA HEALTH CENTER, INC
02.1999 - 07.1999
Allied Health Professional Medical Scribe - Allied Health Professional Advanced Fast Track
American Healthcare Documentation Professionals Group (AHDPG)
CPC-A And ICD-10-CM Proficiency - Professional Medical Coding Curriculum, AAPC Align
The American Academy of Professional Coders
Certificate of Completion - Professional Paralegal, Centers For Legal Studies
University of Colorado At Boulder
Accounting - Accounting 26 Credit Hours
Pima Community College
Associate of Science - Chemical Technology "Cert. American Chemical Soc."
City College of San Francisco
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